Shifting Health Care Financial Riskto Families Is Not a ：移动医疗保健财务风险的家庭不是一个课件.ppt

Shifting Health Care Financial Riskto Families Is Not a Sound Strategy:The Changes Needed to EnsureAmericans Health Security,Karen DavisPresidentThe Commonwealth Fundkdcmwf.orgInvited TestimonyHouse Committee on Ways and MeansSubcommittee on HealthSeptember 23,2008,A Broken System:The Growing Numbers of Uninsured,Health Insurance Coverage,Source:Authors estimates based on S.R.Collins,C.White,and J.L.Kriss,Whither Employer-Based Health Insurance?The Current and Future Role of U.S.Companies in the Provision and Financing of Health Insurance(New York:The Commonwealth Fund,Sept.2007)and analysis of the Current Population Survey,March 2008,by Bisundev Mahato of Columbia University.,Uninsured(15%),Employer(55%),45.7 Million Uninsured,2007,Medicaid(10%),Medicare(13%),Total population,Under-65 population,Employer(62%),Uninsured(17%),Medicaid(11%),Medicare(2%),Military(1%),Military(1%),Individual(5%),Individual(6%),Source:P.Fronstin,“Sources of Health Insurance and Characteristics of the Uninsured:Analysis of the March 2008 Current Population Survey”Issue Brief No.321(Washington,D.C.:Employee Benefit Research Institute,Sept.2008).,Percentage of Uninsured Children Has DeclinedSince Implementation of SCHIP While UninsuredWorking-Age Adults Have Increased,19942007,Percent of population group uninsured,Non-elderly Adults(Ages 1864),Children(Ages 017),Source:DeNavas-Walt C,Proctor B,and Smith J.“Income,Poverty,and Health Insurance Coverage in the United States:2007.”Washington:Census Bureau,2008.,Uninsured Rates,by State,Two-Year Average,200607,TX 24.8%,MA7.9%,Inadequate Coverage:The Rise of the Underinsured,25 Million Adults Underinsured in 2007,Up from 16 Million in 2003,Uninsuredduring the year49.5(28%),Insured all year,notunderinsured102.3(58%),Insuredall year,underinsured25.2(14%),2007Adults ages 1964(177.0 million),Uninsuredduring the year45.5(26%),Insured all year,notunderinsured110.9(65%),Insuredall year,underinsured15.6(9%),2003Adults ages 1964(172.0 million),*Underinsured defined as insured all year but experienced one of the following:medical expenses equaled 10%or more of income;medical expenses equaled 5%or more of income if low-income(200%of poverty);or deductibles equaled 5%or more of income.Source:C.Schoen,S.R.Collins,J.L.Kriss,and M.M.Doty,“How Many Are Underinsured?Trends Among U.S.Adults,2003 and 2007,”Health Affairs Web Exclusive,June 10,2008.Data:Commonwealth Fund Biennial Health Insurance Surveys(2003 and 2007).,Almost Three-Fourths of Low-Income AdultsAges 1964 Are Uninsured and Underinsured,2007,*Underinsured defined as insured all year but experienced one of the following:medical expenses equaled 10%or more of income;medical expenses equaled 5%or more of incomes if low-income(200%of poverty);or deductibles equaled 5%or more of income.Data:2007 Commonwealth Fund Biennial Health Insurance Survey(Schoen et al.2008).,32,72,27,An Estimated 116 Million Adults Were Uninsured,Underinsured,Reported a Medical Bill Problem,and/orDid Not Access Needed Health Care Because of Cost,2007,Medical bill/debt problem17.7 million10%,Cost-related access problem25.9 million15%,Source:The Commonwealth Fund Biennial Health Insurance Survey(2007).,Adequate coverage and no bill or access problem61.4 million35%,Uninsured anytime during the year or underinsured17.6 million10%,Medical bill/debt andcost-related access problem54.4 million31%,177 million adults,ages 1964,Uninsured and Underinsured Adults ReportHigh Rates of Cost-Related Access Problems,Percent of adults ages 1964 who had cost-related access problemsin the past 12 months,Source:The Commonwealth Fund Biennial Health Insurance Survey(2007).,Sixty Percent of Adults Who Were Underinsured or Uninsured Reported Medical Bill Problems or Debt,Percent of adults ages 1964,*Includes only those individuals who had a bill sent to a collection agency when they were unable to pay it.Source:The Commonwealth Fund Biennial Health Insurance Survey(2007).,Insured Adults with Less Comprehensive Coverage and Benefit Limits Are More Likely to Face Medical Bill and/or Debt Problems,Percent of continually insured adults ages 1964 with bill and/or debt problems,Source:The Commonwealth Fund Biennial Health Insurance Survey,2007.,MD did not charge more than insurance coveredMD charged more than insurance would pay;patient paid difference,Health plan does not limit total dollar amountHealth plan limits total dollar amount,Annual premium is less than 10%of incomeAnnual premium is 10%or more of income,Deductible is less than 5%of incomeDeductible is more than 5%of income,Has both Rx and Dental CoverageHas neither Rx nor Dental Coverage,No expensive bills for services not coveredHad expensive medical bills for services not covered by insurance,Underinsured Adults Report Higher Rates of Health Insurance Plan Problems than Adults with Adequate Insurance,Percent of adults ages 1964 who were insured all yearand had problems with health insurance plan,Source:The Commonwealth Fund Biennial Health Insurance Survey(2007).,Prescription Drug Cost-Sharing,Average Copayments Among Covered Workers,20002007,Source:Kaiser Family Foundation/Health Research and Educational Trust,Employer Health Benefits,2007 Annual Survey.,Annual Outpatient Visits Coverage Among Workers with Mental Health Coverage,2006,All Plans,No Limit13%,20 or Less35%,213030%,315014%,508%,Source:Kaiser Family Foundation/Health Research and Educational Trust,Employer Health Benefits,2007 Annual Survey.,Uninsured and Underinsured Adults with Chronic ConditionsAre More Likely to Visit the ER for Their Conditions,Percent of adults ages 1964 withat least one chronic condition*,*Hypertension,high blood pressure;heart disease;diabetes;asthma,emphysema,or lung disease.*Adults with at least one chronic condition who take prescription medications on a regular basis.Source:The Commonwealth Fund Biennial Health Insurance Survey(2007).,Coverage Is Eroding in Small Firms,Employer Coverage Continues to Erodefor Employees of Small Firms,Percent of firms offering health benefits,Source:S.R.Collins,C.White,and J.L.Kriss,Whither Employer-Based Health Insurance?The Current and Future Role of U.S.Companies in the Provision and Financing of Health Insurance(New York:The Commonwealth Fund,Sept.2007).Data:The Kaiser Family Foundation/Health Research and Educational Trust,Employer Health Benefits,2000 and 2007 Annual Surveys.,Three of Five Workers with Any Time Uninsured AreSelf-Employed or in Firms with Fewer than 100 Workers,Self-employed/1 employee12%,2099 employees17%,Source:The Commonwealth Fund Biennial Health Insurance Survey(2007).,Full-time or part-time working adults ages 1964with any time uninsured,by employer size(27.5 million),500 or more employees19%,219 employees30%,100499 employees15%,Dont know/refused7%,Single Premium by Size of Firm,Adjusted for Actuarial Value,Dollars,Source:J.Gabel,R.McDevitt,L.Gandolfo et al.,“Generosity and Adjusted Premiums in Job-Based Insurance:Hawaii Is Up,Wyoming Is Down,”Health Affairs,May/June 2006 25(3):83243.,Source:Kaiser Family Foundation/Health Research and Educational Trust,Employer Health Benefits,2007 Annual Survey.,Small-Firm Workers More Likely than Large-FirmWorkers to Contribute Large Share of Premiumfor Family Coverage,All Firms,Large Firms(200+workers),Small Firms(3199 workers),Deductibles Have Risen Sharply,Especially in Small Firms,Over 20002007,PPO=preferred provider organization.PPOs covered 57 percent of workers enrolled in an employer-sponsored health insurance plan in 2007.Source:The Kaiser Family Foundation/Health Research and Educational Trust,Employer Health Benefits,2000 and 2007 Annual Surveys.,Mean deductible for single coverage(PPO,in-network),Source:Kaiser Family Foundation/Health Research and Educational Trust,Employer Health Benefits,2007 Annual Survey.,Deductible for Single Coverageby Plan Type and Firm Size,2007,People with ESI*Who Say That EmployersDo a Good Job Selecting Quality Insurance Plans,Percent,*ESI=employer-sponsored insurance.FPL=federal poverty level.Note:Based on respondents age 19-64 who were covered all year by their own employers insurance.Source:S.R.Collins,J.L.Kriss,K.Davis,M.M.Doty,and A.L.Holmgren,Squeezed:Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families,The Commonwealth Fund,September 2006.,%FPL,Number of employees in firm,Individual Insurance Market WorksLess Well than Employer Coverage,Individual Market Is Not an Affordable Option for Many People,Source:S.R.Collins,J.L.Kriss,K.Davis,M.M.Doty,and A.L.Holmgren,Squeezed:Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families,The Commonwealth Fund,September 2006.,Adults with Employer CoverageGive Their Health Plans Higher RatingsThan Those in the Individual Market,Source:S.R.Collins,J.L.Kriss,K.Davis,M.M.Doty,and A.L.Holmgren,Squeezed:Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families,The Commonwealth Fund,September 2006.,53,54,34,Percent of adults ages 1964 insured all year with private insurance,Health Care Costs Concentrated in Sick FewSickest 10%Account for 64%of Expenses,1%,5%,10%,49%,64%,24%,Source:S.H.Zuvekas and J.W.Cohen,“Prescription Drugs and the Changing Concentration of Health Care Expenditures,”Health Affairs,Jan/Feb 2007 26(1):249257.,Distribution of health expenditures for the U.S.population,by magnitude of expenditure,2003,50%,97%,$36,280,$12,046,$6,992,$715,Expenditure Threshold(2003 Dollars),Risk Pooling and Employer Premium Contributions Lower the Cost of Health Benefits for Adults with Employer Coverage Relative to Those with Individual Market Coverage,20,18,54,Percent of adults ages 1964 insured all year with private insurance,Source:S.R.Collins,J.L.Kriss,K.Davis,M.M.Doty,and A.L.Holmgren,Squeezed:Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families,The Commonwealth Fund,September 2006.,Public Programs Work,Only Two Percent of Premiums in Medicare and Medicaid Are Spent on Non-Medical Expenditures,Percent of premiums spent on non-medical expenditures,Source:K.Davis,B.S.Cooper,and R.Capasso,The Federal Employees Health Benefit Program:A Model for Workers,Not Medicare,The Commonwealth Fund,November 2003;M.A.Hall,“The Geography of Health Insurance Regulation,”Health Affairs,March/April 2000 19(2):17384.,Medicaids Spending on Health ServicesIs Lower Than That of Private Coverage,Expenditures($)on health services for people without health limitations in private coverage and Medicaid,Source:J.Hadley and J.Holahan“Is Health Care Spending Higher Under Medicaid or Private Insurance?”Inquiry,Winter 2003 40(4):32342.,Percent Annual Per Enrollee Growth inMedicare Spending and Private Health Insuranceand FEHBP Premiums for Common Benefits,Percent,*FEHBP estimates are for 19692002 and 19992002 from Levit et al.,“Health Spending Rebound Continues in 2002,”Health Affairs 23(January/February 2004):14759.Source:Analysis by Office of the Actuary,Centers for Medicare and Medicaid Services,January 2005.,Medicare Extra Plan Would LowerAnnual Premiums for Individuals and Families,Source:C.Schoen,K.Davis,and S.R.Collins,“Building Blocks for Reform:Achieving Universal Coverage with Private and Public Group Health Insurance,”Health Affairs,May/June 2008 27(3):64657;G.Claxton,“Health Benefits in 2007:Premium Increases Fall to an Eight-Year Low,While Offer Rates and Enrollment Remain Stable,”Health Affairs,September/October 2007 26(5):140716.,Medicare Beneficiaries Have Better Access toPhysician Services than Privately Insured People,2005,Percent,Never had a delay to appointment,No problem finding physician,Source:MedPAC Report to the Congress:Medicare Payment Policy,March 2006,p.85.,Rising Premiums and Insurance Administrative Costs,Source:Kaiser/HRET Survey of Employer-Sponsored Health Benefits,2007,and Commonwealth Fund analysis of National Health Expenditures data.*Estimate is statistically different from the previous year shown at p0.05.Estimate is statistically different from the previous year shown at p0.1.Note:Data on premium increases reflect the cost of health insurance premiums for a family of four.Historical estimates of workers earnings have been updated to reflect new industry classifications(NAICS).,Increases in Health Insurance Premiums Compared with Other Indicators,19882006,Percent,Cumulative Changes in Annual National Health Expenditures and Other Indicators,20002007,Notes:Data on premium increases reflect the cost of health insurance premiums for a family of four/the average premium increase is weighted by covered workers.*2006 and 2007 private insurance administration and personal health care spending growth rates are projections.,109%,65%,91%,24%,Percent change,Sources:A.Catlin,C.Cowan,S.Heffler et al.,“National Health Spending in 2005:The Slowdown Continues,”Health Affairs,Jan./Feb.2007 26(1):14353;J.A.Poisal,C.Truffer,S.Smith et al.,“Health Spending Projections Through 2016:Modest Changes Obscure Part Ds Impact,”Health Affairs Web Exclusive(Feb.21,2007):w242w253;Henry J.Kaiser Family Foundation/Health Research and Educational Trust,Employer Health Benefits Annual Surveys,20002007(Washington,D.C.:KFF/HRET).,Percentage of National Health ExpendituresSpent on Insurance Administration,2005,a 2004 b 2001*Includes claims administration,underwriting,marketing,profits,and other administrative costs;based on premiums minus claims expenses for private insurance.Data:OECD Health Data 2007,Version 10/2007.Source:Commonwealth Fund National Scorecard on U.S.Health System Performance,2008,Net costs of health insurance administration as percent of national health expenditures,a,a,a,b,Administrative Hassles Related toMedical Bills and Insurance Are Serious Problemsfor More Than a Quarter of Adults,Source:S.R.Collins,J.L.Kriss,K.Davis,M.M.Doty,and A.L.Holmgren,Squeezed:Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families,The Commonwealth Fund,September 2006.,28,40,26,Percent reporting serious problems spending time on paperwork or disputes related to medical bills and health insurance in past two years,Concentration of Managed Care Enrollment,19882000,Note:The largest national managed care firms include Blue Cross and Blue Shield plans,Aetna US Healthcare,Kaiser Permanente,United Health,and PacifiCare.HMO enrollment includes enrollees in both traditional HMOs and point-of-service plans.Source:Centers for Medicare and Medicaid Services,CMS Chart Series,Table 1.17.,Two-thirds of managed care enrollees are enrolled in the nations 10 largest managed care firms.,Percent enrolled in 10 largest firms,WA,OR,ID,MT,ND,WY,NV,CA,UT,AZ,NM,KS,NE,MN,MO,WI,TX,IA,IL,IN,AR,LA,AL,SC,TN,NC,KY,FL,VA,OH,MI,WV,PA,NY,MD,ME,VT,NH,MA,RI,CT,DE,DC,CO,GA,MS,OK,NJ,SD,Market Share of Three LargestHealth Plans,by State,20022003,Note:No data are available for Alaska and Hawaii.Sourc